Food addiction and other causes of abnormally high hunger

Do you feel hungry all the time? Abnormally hungry? If so, it’s worth trying to figure out why. Potential drivers of abnormally high hunger include insulin resistance, gut and microbiome issues, low blood sugar, and food addiction—just to name a few.

In this episode, Lara explores food addiction and some of the controversy around the term. She also discusses the next best steps on the road to recovery. 

Links: 

• Lara's new book about metabolic health
• Poll: Addiction to highly processed food among older adults
• Dr. Jen Unwin's Resource page

Transcript

Do you feel hungry all the time? Abnormally hungry? If so, it’s worth trying to figure out why. Potential drivers of abnormally high hunger include insulin resistance, gut and microbiome issues, and a tendency to low blood sugar—just to name a few. Another potential driver or mechanism of abnormally high hunger is food addiction, which is controversial but, I would say, very real for some people.

Welcome back to the podcast. I’m your host, Lara Briden, a naturopathic doctor and author of the books Period Repair Manual, Hormone Repair Manual, and a new book about metabolic health called Metabolism Repair for Women in most parts of the world, and The Metabolism Reset in Australia and New Zealand. Two titles; the same book. The book will be out on the 28th of May 2024. And today’s episode is a little teaser of just some of what it contains.

First, hunger is not under conscious control—which should seem obvious, really, except that we’ve had several weird decades of calorie-counting advice based on the faulty assumption that hunger is somehow under conscious control. According to Professor Barbara Corkey, past president of the Obesity Society, “The [narrative] that obesity is caused by eating too much and exercising too little . . . is nonsense. [Conscious overeating] is not the explanation,” she says, “because all . . . creatures on Earth, including humans, eat when they’re hungry and stop when they are full. Every cell in the body knows if you have had enough food. Something has disrupted that normal sensing apparatus.”

What Professor Corkey calls a hunger-sensing apparatus is also sometimes called “set point,” an appetite regulatory mechanism, or “adipostat,” meaning “fat thermostat.” It’s a part of the brain—specifically of the hypothalamus—that regulates hunger and fullness, also called satiety.

That same mechanism simultaneously regulates energy expenditure because the neurons that control hunger are closely connected with the neurons that control unconscious energy expenditure or the unconscious burning off of energy. And again, this mechanism is not under conscious control … for anyone. If your regulatory mechanism is set to a healthy satiety, it will be much easier to eat less and not snack. If, however, it’s set to high hunger, it could be very difficult—impossible, basically, to eat less. As Professor Corkey said, for a lot of people, something has disrupted that regulatory mechanism.

But what? Well, scientists are scrambling to figure that out, but the ultimate cause of the dysfunction is likely a combination of factors in our modern world, including environmental toxins, medications, and, of course, our modern food environment, especially ultra-processed food. It’s not just that ultra-processed food is “delicious, and so creates hedonic overdrive,” says researcher Kevin Hall in one of his interviews. It’s also that ultra-processed food seems to reset our satiety mechanism. “Or bypass it,” he said, “or perhaps just break it completely.”

And the problem is not only the ultra-processed food we eat now—today—but also all the ultra-processed food and other toxins we were exposed to as kids and maybe even before we were born. That’s because such environmental exposure can create epigenetic (or heritable) changes that can make us hungrier, less able to burn energy, and more likely to store fat. In other words, environmentally-induced metabolic dysfunction can be passed on to future generations via epigenetics.

So… your current situation of being hungrier than normal and gaining weight could be the result of something that happened when you were a kid or maybe even before you were born. It’s really cruel and unfair, but you can still do something about it.

As you’ll see in my new book—which is essentially a troubleshooting manual—repairing that broken satiety mechanism requires identifying and correcting various drivers or mechanisms of abnormally high hunger, such as insulin resistance, leptin resistance, gut and microbiome problems, a tendency to low blood sugar—which (by the way) is made worse by insulin resistance, medication, circadian disruption, food sensitivities, stress,
female hormone issues, nutrient deficiency, and more. All of these are addressable or reversible.

There is also food addiction, our topic today—also addressable and reversible. And, the concept of addiction is controversial, I realize that, but I want to explore it just a little today and hopefully get some of your feedback as to how to tackle the topic in future posts and videos.

So, what is food addiction exactly? Well, It’s a controversial term that describes—potentially describes— the compulsive and uncontrollable eating of certain foods (usually ultra-processed foods) despite negative consequences, with an inability to reduce consumption despite the desire to do so, and potentially withdrawal symptoms when the foods are stopped.

Food addiction involves the reward system, which is like the brain’s motivational conductor. The reward system orchestrates all our desires, motivations, and cravings and tags experiences— including eating experiences with a shot dopamine shot to tell the brain: “This is good; let’s do it again.” The reward system itself is not bad. In fact, without it, we would never want anything or do anything. But the reward system can become a problem when it becomes hijacked by an addictive substance. In that case, you’ll end up needing more and more stimulus—such as a sugary drink or food—just to get the same hit. That’s because, with every big dopamine hit, the brain reduces the number of dopamine receptors. So, you need more of the substance just to get the same effect.

“I always try to explain to patients about the dopamine high,” says clinical psychologist and food addiction researcher Dr Jen Unwin, “and how [it] starts the craving, which makes people [search for] the next sugar hit. Just thinking about the next chocolate bar gets the dopamine running for many people, and the more they tread this path, the worse it gets because the dopamine receptors keep reducing.”

Dr Unwin is just one of several researchers working in this field. Others include Professor Ashley Gearhardt, who formulated a clinical assessment tool called the Yale Food Addiction Scale, and associate Professor Jeffrey Kullgren, who said in an interview that “We need to understand that cravings and behaviors around food are rooted in brain chemistry and heredity and that some people may need additional help just as they would to quit smoking or drinking.”

According to a 2023 poll conducted by Professors Gearhardt and Kullgren—link in the show notes—at least one in eight people over age 50 show signs of food addiction. That number is even higher in women. So, it’s not a small problem. To be fair, the symptoms of food addiction overlap quite a bit with eating disorders. That overlap is a big part of the controversy.

Another part of the controversy is the word addiction itself and how, for some people, the word addiction still means a vice or a moral failing. To be clear, that’s the old definition of addiction—decades old. For at least a couple of generations, society has viewed addiction not as a moral failing but as a health condition that can potentially affect anyone, regardless of their morality or willpower. Importantly, people with smaller body sizes can also have food addiction, so it’s truly not about body weight or size.

Okay. If some of this has resonated with you… For example, If you or someone you know has been experiencing life-disrupting, out-of-control food cravings, then what is the next best step?

Step one is to try to get a diagnosis. Ideally, that would involve a sympathetic clinician who can apply the Yale Food Addiction Scale. Assessment can also be accessed by participating in one of the support groups listed in my book and on Dr. Jen Unwin’s resource page at forkintheroad.co.uk. After that, you’ll need to line up support, whether that’s from a clinician or a support group, or both. Every expert I’ve spoken with agrees that recovering from food addiction is not something a person can go alone.

You’ll also need physical support, which can come from getting enough rest and sleep, as an example — and eating enough protein as another example. Supplements can also be helpful—I would say—especially magnesium, which can calm the nervous system, stabilize blood sugar, and reduce sugar cravings.

And you’ll need a plan, which will likely involve counseling or support groups. The plan should almost certainly also involve identifying a list of trigger foods or foods that trigger or cause abnormally high hunger. And then picking a start date to begin trial abstinence from those foods. If you feel panicked at the thought of abstinence from certain foods, let me assure you that the plan is not to feel permanently deprived or to feel constant hunger because that would be torture. Instead, the plan is “food freedom,” in the words of my colleague Dr Karen Faisandier, who you’ll meet in the book. Food freedom means no more cravings and a hunger that has returned to normal.

If you find that difficult to imagine, let me assure you that it is possible. I’ve seen it with my patients. And I can assure you that there is a place and a way of being that does not require being constantly hungry or constantly having to exert willpower. As to exactly how to get that place, it’s going to be your individual journey, recruiting the right support, first and foremost, troubleshooting trigger foods and addressing any other metabolic obstacles, such as for example, digestion problems or food sensitivities. See my book for all about what I call metabolic obstacles.

One thing I can say with great certainty is that the mantra of “everything in moderation” is not part of a successful plan for food addiction, at least not in the short term. And yes, this is a dramatic departure from the old willpower, calories-in calories-out approach. It’s a different way of doing things. But I encourage you to consider it.

And, of course, at this point, you may be wondering, “But which foods are trigger foods? Which are the foods that need to be avoided?” As mentioned, trigger foods are foods that do not create satiety but instead actively (in some people) stimulate hunger. And, to be clear, people who don’t have food addiction don’t really have trigger foods. And even amongst people who do have food addiction, the trigger foods are going to be different for different people. That’s why I simply can’t provide a definitive list.

But just to give you a sense, trigger foods are usually—not always, but usually—ultra-processed food, such as chips, cookies or biscuits, granola or muesli bars,
sweetened yogurts, and even—for some people, bread, especially commercial or packaged bread, which has ultra-processed ingredients. Now, that is not to say that bread is a problem for every person—clearly, it is not. Bread can be healthy for some people, especially better quality bread, not commercial or packaged bread—especially for people without food addiction. Bread can be a reasonable part of the diet. At the same time, bread can be a big, big problem for some people, especially people with food addiction. For example, in the book, I share the story of my patient Lexi, who finds—discovered—that bread actively makes her feel more hungry when she eats it.

Okay, that was a little introduction to the concept of food addiction, which might help you find your starting place. Because what you need going forward very much depends on where you are right now. And if you are—or think you might be—in a place of food addiction, please seek further information and help from Dr Jen Unwin’s excellent resource page, forkintheroad.co.uk. And, of course, from my new book, Metabolism Repair for Women, or The Metabolism Reset, depending on your country. And remember, the road to recovery is with lots of help and step-by-step.

Also, remember: Food addiction is only one of several possible drivers or mechanisms of abnormally high hunger. Another really important one is a tendency to hypoglycemia or low blood sugar. As it turns out, the symptoms of food addiction—hunger and intense cravings for highly palatable foods, usually sugary and high-carb foods, and possible withdrawal symptoms (including shakiness) when those foods are stopped—are quite similar to the symptoms of low blood sugar or hypoglycemia, which would be hunger, shakiness, and sometimes an intense need for sugary and high-carb foods. The big difference between food addiction and hypoglycemia is that recovery from food addiction can be a long road—long journey—while treatment of hypoglycemia is relatively straightforward with the blood sugar-stabilizing strategies that we’ll discuss in the next episode and in my book. And, just to say, of course, you could have both—food addiction and hypoglycemia.

Finally, please share your thoughts about this topic. Do you find food addiction a helpful concept? If not, why not? Bearing in mind that it may simply not apply to you, which is fine. And what other food addiction recovery resources can you suggest? —can you potentially share with the other listeners of this podcast.

You can leave a comment on the YouTube video, on the blog post associated with this episode at LaraBriden.com, or in my forum—on the topic that I’ll create for this episode. I hope that’s been helpful, and thanks so much for listening. Please share and leave a review. And I’ll see you next time when I’ll discuss low blood sugar and what you can do about it.